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HI Deals With Chronic 911 Callers


Sunday, November 4, 2012 From the Star Advertiser:

 In hopes of giving better care and saving money, the Honolulu Emergency Services Department will begin deploying "community paramedics" to help people who call 911 so often that they are on a first-name basis with the dispatchers.

"The top 50 callers to 911 are on track to make 1,600 calls this year," said Dr. James Ireland, director of emergency services. "If you're calling 911 and going to the emergency room every couple of days, obviously something's wrong."

More than 70 percent of the top 50 callers have chronic medical issues, which if left untended can lead to emergencies. About a third are homeless. A third have mental illness.

"Some call because they can't breathe, but they can't breathe because they don't have their medicine," Ireland said. "The problem is if you don't have a doctor, you don't have access to medicine. If you have an untreated mental illness, the cycle of calling 911 and going to the ER is not going to fix that."

Rather than reacting to 911 calls, the community paramedics will take the initiative, reaching out to these frequent callers in person in hopes of uncovering the source of their problems. The plan for the pilot program is to visit the top 50 callers once a week, whether they are at home, at a shelter or in a park, and guide them to the social and medical support they need.

"What we want to do is have a system for these vulnerable patients so that we can find out what is the reason they keep calling 911," he said. "Is it access to medicine? Is it access to shelter? We're going to connect folks to various resources in the community. We're going to short-circuit this cycle of using Emergency Medical Services and the ER."

The pilot, announced Saturday and slated to begin by the end of the year, aims to cut the number of 911 calls by the top 50 clients in half. The cost savings could be dramatic.

Each ambulance ride costs about $800 and each emergency room visit runs about $800, according to the Emergency Services Department. That puts the direct cost for the top 50 at $2.6 million this year.

When the projected cost of hospitalization for those who are admitted is factored in, the tab for the top 50 callers could run as high as $7 million this year, or roughly $140,000 per patient, Ireland said.

"Unlike the 911 ambulance, our goal is not to take them to the hospital," Ireland said. "The goal with this system is to keep them out of the hospital, out of the ER. We feel people will get better overall care, which is our primary goal, but it will also ease the financial burden on the system."

Patients will be given a hotline number to reach the community paramedic, rather than automatically relying on 911, although everyone should call 911 in true emergencies.

The Emergency Services Department has been meeting with community partners to develop the program, including the Queen's Medical Center, the University of Hawaii Medical School, social service and homeless shelter providers.

"We think as a team, that's the solution," Ireland said. "Because alone we're not going to fix anything. We feel very strongly that we have to work with the homeless shelters, we have to work with the psychiatrists, we have to work with the community health centers because they're the key to addressing the root causes."

As people on the top 50 list "graduate" from the program, visits can be dialed back, and new people with acute needs can be helped through the system.

Costs of the pilot project are minimal, pegged at $150,000. To start with, two community paramedics will work Monday through Friday, aiming to visit each of the top 50 callers once a week, if the patients are willing to cooperate.

They will use a retired ambulance that was buffed up and repainted with a gold stripe rather than the typical ambulance orange and the words "Community Paramedic Unit" on its side. The community paramedics will wear less formal uniforms: a black polo shirt and khaki pants.

Chris Luan, a paramedic and dispatcher, came to Ala Moana Beach Park Saturday to introduce the program, and said she is eager to try out the job of community paramedic.

"I love being able to help people, not just the emergency part of it but the compassionate part," Luan said. "This way we will be able to spend more time with the patients. That's what I like about it."

"As a dispatcher and as road personnel, you know their voice, you know their address, you know them by first name."

For those who volunteer to try it, being a community paramedic might provide a welcome change of pace from the hectic, adrenaline-fueled pace of ambulance life, with its high stress, lights and sirens.

"Being a paramedic on the road is very challenging and very draining," Luan said. "The attrition rate is very high. This could give our paramedics a break from that, to be able to slow down and be more compassionate and spend time with these people."

Some rural communities on the mainland have been trying the community paramedic system, which originated in Canada. In Hon­­o­lulu, the program will focus on the socioeconomically isolated, Ireland said. Along with giving personalized care and saving money, the program should help ease emergency room overcrowding.

"We're not going to force this on anybody," Ireland said. "But we feel that if they are calling 911, they are reaching out for help, so we feel they will be receptive."


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